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The MDU's medico-legal adviser Dr Sally Old on how to deal with a partner you suspect could be putting patients at risk by practicing under the influence of alcohol.

A GP noticed one of her partners was regularly late starting surgery, had forgotten to sign prescriptions on a couple of occasions and had become irritable and withdrawn. One morning, the GP noticed the smell of alcohol on her colleague's breath and that his speech was slurred.

The receptionist also mentioned that she thought she could smell alcohol on the partner's breath. The GP rang the MDU to ask what she should do. She was worried about raising concerns about her colleague because he was an experienced member of the team.

The MDU advised that the care of patients was the principal concern and arrangements needed to be made without delay to ensure their safety. The GMC1 states that a doctor's primary duty is to his or her patients.

If a doctor feels that patient safety is at risk due to a colleague's conduct, performance or health then he or she has an obligation to take steps to protect them. In this instance, the MDU advised the GP to ask her colleague not to see patients that morning and arrange a time to discuss the situation with him later in the day. She was also advised to record in writing her concerns and all the actions taken.

The MDU advised that the GP risked criticism by the GMC if she ignored her concerns about his ill health that resulted in harm to patients.

The GP discussing her concerns with her colleague in the first instance, may lead to an admission by him that there is a problem and he may then seek appropriate help. If he denied there was a problem or refused to seek help then the GP was advised she would have an obligation to take the matter further if she still had concerns that his conduct might affect patient safety. This could be to a senior partner in the practice, the Local Medical Committee or the Primary Care Trust.

The GP's final recourse would be to inform the GMC of her concerns, although the GMC says this will usually be when there are no appropriate local systems or local systems do not resolve the problem and there is a continuing risk to the safety of patients. 2

Learning points

• Doctors may be reluctant to report concerns about a colleague, however, the GMC advises that patients' interests must come first and protecting them must override personal and professional loyalties. 1

• It is important to be "clear, honest and objective about the reason for your concern" and to "keep a record of your concern and any steps that you have taken to resolve them". 2

• Doctors reporting legitimate concerns about a colleague's conduct, through recognised channels, in a factual way, may be protected by the Public Interest Disclosure Act 1998. 3

• Organisations such as the Sick Doctors Trust can offer help to sick colleagues.